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Optimizing The Technologies That Y our Facility H as In Place

Optimizing The Technologies That Y our Facility H as In Place . Candice A. Powers, MBA Director of Revenue Cycle Beaufort Memorial Hospital. Traditional Revenue Cycle. Nothing New. Areas are often operated in Silos Lacking integration with bolt on technologies

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Optimizing The Technologies That Y our Facility H as In Place

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  1. Optimizing The Technologies That Your Facility Has In Place Candice A. Powers, MBA Director of Revenue Cycle Beaufort Memorial Hospital

  2. Traditional Revenue Cycle

  3. Nothing New • Areas are often operated in Silos • Lacking integration with bolt on technologies • As a result processes are fragmented • People and their responsibilities get lost in translation • Results in lost productivity, increased cost and underperformance

  4. Five Zone Strategy HIS

  5. Keep the analysis to the 5 zones initially • Searching for Gaps, hoping for no HOLES • Be sure to spend time with front line staff as well as managers and directors Preparing the Gap Analysis

  6. Report:TechnologyPrimary FunctionSecondary/Tertiary FunctionLocale in Rev CycleCosts • Process • Technology 2 questions: What works? What could work better?

  7. Optimal state

  8. Remember?

  9. Optimal state

  10. Scheduling, Authorization, Registration, FC must become more blended, integrated • Assess: • Financial clearance technology • Eligibility • Batch eligibility verification • Propensity Assistance • Med NecScreening/Order Level • Quality Assurance technology and/or process • Integrate eligibility/propensity/Med Nec/QA info into the master HIS Before Encounter

  11. Billing and Posting • HIS capabilities • CCI • Unit discrepancies • Plan code discrepancies • Facility misinformation • REPORT AND FOLLOW UP • Claims Clearinghouse • Bridge routines • Productivity reporting • Take the time to eliminate the paper (less than 5%) • Alias payers daily and report back • Can you claim status? • What is your first pass yield rate? • Cash Posting • Again NO PAPER Post Encounter

  12. Worklisting • CATCH ALL LIST • Review and trend aging monthly • Reallocate resources in measurable increments Post Encounter

  13. Financial Counseling • What info do you have or can you get PRE ENCOUNTER? • Post encounter is a completely different ballgame • Essential for Non Profits • USE the propensity information you have now integrated • Under 501R, presumption becomes essential • Connect advocacy resources within the health system and community • Automation??? • Discounts at POS? SP? • Collections • Access and transparency • Cut costs by collecting address information and feed back to HIS • Review the patient portal. How much functionality is present? • Ask questions of your partners and include them in every process change discussion • Using same propensity scoring for net 30 discount? Collections

  14. Denials • Full ANSI/Denial code review of your top 10 • Strip the reporting directly from the 835 • Standardize follow up procedure to identify and use CAS codes when adjustment taken on non 835(less than 5% remember) • Feed HIS statuses of the progress • Standardize reporting • Underpayments ARE underhanded denials • Total Claim/Total Submitted Claim/Total Denied/Net Reimbursement/Recovery • Audits • Standardize reporting • Audits will provide the roadmap for clinical improvement and administrative improvement • Are you capturing secondary denials info Denials/Audits As a hospital, do we have access to the physician owned practice clinical documentation???

  15. Where should we develop resources for success? You are where you are because you are good. Without team support, your success will be minimal.

  16. BE PROACTIVE • Provide opportunities for larger picture education • HFMA is an excellent resource for staff development

  17. Evaluation process for technology holes • Check HFMA for reputable companies • Ask around, do NOT use only references provided • Evaluate until you find a fit • Do not settle • Grading system with a comment from each team member • Down to top three, more in depth review and rank • DO NOT DO THIS YOURSELF WITH ADMINISTRATION INCLUDE A TEAM OF BOOTS AND REV CYCLE RESOURCES FROM AREA AND THE TOUCHPOINTS

  18. SimplifyCheck the engine firstAsk the question to more than one personCheck the engine againSpeak up CREATE THIS CULTURE!!!!

  19. The next few years/decade in our industry

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